Rapid and inexpensive assays for drug susceptibility testing (DST) of Mycobacterium tuberculosis (MTB) are urgently required especially in developing countries where tuberculosis cases are prevalent. In response to this necessity, a direct microplate-based colorimetric assay which excludes the use of pre-testing culture isolate was evaluated. MTB susceptibility to the first line anti-tuberculosis drugs was tested directly on sputum specimens using tetrazolium microplate assay (TEMA) method and the sensitivity, specificity, accuracy as well as mean turn-around time of TEMA were compared to the standard absolute concentration method (ACM). TEMA was performed on 41 acid fast bacilli (AFB) positive sputum specimens by direct inoculation of the processed specimens into the microplate wells containing serialdiluted first line anti-tuberculosis drugs using tetrazolium dye as growth indicator. Indirect TEMA was performed on MTB isolates of the corresponding samples. The minimum inhibitory concentrations (MICs) of isoniazid (INH), rifampicin (RMP), ethambutol (EMB) and streptomycin (SM) were obtained for direct and indirect TEMA with reference to the absolute concentration method (ACM). After establishing the breakpoint MIC of each drug using receiver operating characteristics (ROC) curve, reliable results from direct TEMA were obtained for INH and SM, with excellent levels of sensitivity, specificity, and accuracy (more than 90%). The predictive values for susceptibility were 100% for INH, EMB and SM as well as 96% for RMP. A shorter mean turn-around time of 14 days was observed for direct TEMA (P < 0.05). Thus direct TEMA is potentially rapid, reliable and inexpensive DST screening method of MTB in countries with high prevalence rates of drug resistance tuberculosis

Objective: The purpose of the study was to determine the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of post mortem computed tomography (PMCT) in detecting liver and splenic injuries due to road traffic accidents. Material & Method: 61 road traffic accidental death cases underwent both PMCT and conventional autopsy. The imaging findings were compared to the conventional autopsy findings. Result: The sensitivity, specificity, PPV and NPV for liver injuries in PMCT was 71%, 82%, 68% and 85% while that of splenic injuries was 73%, 80%, 55% and 90% respectively. The accuracy of PMCT scan was 79% for both liver and splenic injuries. There is strong association between lower left ribs fracture and splenic injury (p=0.005) and significant association between positive liver and splenic PMCT finding and intraabdominal fatal injury (p=0.037). Conclusion: In conclusion PMCT has high specificity and NPV for liver and splenic injuries; however the sensitivity and PPV are low. The overall accuracy is not high enough to enable PMCT to be used as a replacement for conventional autopsy; however it is a useful complementary examination and has potential to be used as decision making tool for selective internal autopsy.
Autopsy

The objective of this study was to evaluate the antimicrobial potential of methanol, acetone and distilled water stem bark extracts from Canarium odontophyllum against Staphylococcus aureus ATCC 25923, Bacillus cereus ATCC 6633, Escherichia coli ATCC 25932, Pseudomonas aeruginosa ATCC 27853, Acinetobacter baumannii strain sensitive, Candida albicans ATCC 64677, Candida glabrata ATCC 90028, Aspergillus niger and Fusarium solani M2781. The extracts from C. odontophyllum stem bark from 3.125 mg/ml to 25 mg/ml were screened against the tested microorganisms using disc diffusion method. The Minimum inhibitory concentration (MIC) and Minimum Bactericidal Concentration (MBC) of the extracts against susceptible organisms were determined using microbroth dilution method and streak-plate technique, respectively. From the antibacterial screening assay, the growth of S. aureus, B. cereus and A. baumannii were inhibited by methanol extract whereas the acetone extract was capable of inhibiting all the tested microorganisms except E.coli, F. solani and A. niger. The lowest MIC value for methanol extract was against A. baumannii (0.195 mg/ml) whereas its MBC value was twice its MIC value (0.391 mg/ml), indicating that methanol extract was bacteriostatic against A. baumannii. While for acetone extract, S. aureus showed bactericidal effect with equal MIC and MBC values at 0.195 mg/ml. In conclusion, stem bark of C. odontophyllum has the potential to be the source of antibacterial agent and can be exploited as an alternative phytoantimicrobial.

Objective To elucidate the correlation between the enhancement degree of renal clearcell carcinoma (RCC) on dynamic contrast-enhanced CT and multiple vascular morphometric characteristics including microvessels and mature vessels.Methods A retrospective review was carried out on the records of 37 patients pathologically diagnosed with RCC who underwent plain and triphasic contrast-enhanced CT.The absolute (enhancement attenuation-pre-enhancement attenuation) and relative(absolute enhancement value÷cortex enhancement attenuation) enhancement values of RCC were measured in arterial,venous and delayed phases.And all lesions were divided into hypervascular and hypovascular groups.The number,mean area,perimeter and diameter,shape factor (4π*area/perimeter2) and the total area of microvessels and mature vessels were obtained by CD34 or a-SMA immunohistochemical staining.Then the correlation of radiographic parameters and various vascular morphometric parameters were analyzed.Results In arterial,venous and delayed phases,the absolute enhancement values were positively correlated with the number and the total area of microvessels and mature vessels (P<0.05),meanwhile the relative enhancement values were positively correlated with the number of microvessels and mature vessels(P<0.05).In venous and delayed phases,there were negative correlations of the relative enhancement values with mean area,perimeter and diameter of mature vessels(P<0.05).However, no correlations were found between other enhancement and vascular parameters (P>0.05).In addition, the significant differences in the number of microvessels and mature vessels between hypervascular and hypovascular groups were found (P<0.05).Conclusion CT enhancement degrees of RCC are related to multiple vascular morphometric indicators,which gives us more insights in the mechanism of RCC enhancement on CT.

Objective: The smoking rate among patients with mental health problem is higher than in the general population. Effective pharmacotherapy to treat nicotine addiction is thus needed to reduce the morbidity and mortality associated with cigarette smoking among these patients. This article reviews the literature on the suitability of varenicline for smokers with mental health problems. Methods: A search of the literature was conducted using PubMed from year 2001 to July 2009 using key words varenicline alone and varenicline and mental health. Articles chosen were narrowed to those published in English. The type of articles chosen included clinical trials, meta-analyses, case reports, and review articles. Results: The search produced a total of 322 articles on varenicline and 14 articles on varenicline and mental health. Varenicline, a new drug for smoking cessation is an α4β2 partial agonist and partial antagonist at nicotinic acetylcholine receptor. As a partial agonist, varenicline relieves craving and withdrawal symptoms that occur during smoking abstinence and also reduce the rewarding effects of smoking in patients who relapse. However, at present, there is concern regarding the neuropsychiatric side effects such as aggressive behaviour, suicidal ideation, mania and depression associated with varenicline use in patients with mental health problems, but these reports did not show a causal-link or lack of link between these symptoms and varenicline. Conclusion: Current available data support the effectiveness of varenicline to treat nicotine dependence. However its safety among smokers with mental health problems remains to be elucidated. At present, further safety assessment is needed in this patient population. Until new data is available regarding the safety of varenicline in these populations, psychiatrists and physicians prescribing this medication should be extra cautious and monitor for possible psychiatric side effects when prescribing this medication to patients with pre-existing psychiatric disorders or have vulnerability to psychoses.

Aims: Quercus infectoria (QI) gall extract is known to have broad spectrum anti-microbial activity in vitro. However, its mechanism of microbial growth inhibition is not well understood. The objectives of this study were to determine the antimicrobial effect of methanolic QI gall extract on bacteria and yeast and changes to their cell morphology. Methodology and results: The minimum inhibitory concentrations (MICs) of methanolic QI gall extract against Streptococcus agalactiae (ATCC 13813), Proteus vulgaris (ATCC 49312) and Candida albicans (ATCC 10231) were determined using two fold serial microdilution technique at concentrations ranging from 0.01 mg/mL to 5.00 mg/mL (for bacteria) and 0.02 mg/mL to 12.00 mg/mL (for yeast). Minimum bactericidal concentration (MBC) and minimum fungicidal concentration (MFC) were determined by subculturing the broth from the microtitre wells which showed no apparent growth or turbidity onto the nutrient agar plates. The scanning electron microscope (SEM) was used to analyze the morphology of bacteria and yeast cells treated with 1× MIC and 4× MIC of the extract. Substantial antimicrobial activity was observed against ATCC strains of S. agalactiae, P. vulgaris and C. albicans in this study. The MBC/MFC to MIC ratio (≤4) indicated the methanolic QI gall extract was bactericidal and fungicidal against all the tested strains. Changes to the cell morphology were more obvious at higher extract concentration (4× MIC). Conclusion, significance and impact of study: This study showed that QI gall extract has antimicrobial effects on the bacterial and yeast cell morphology and thus, provides scientific information suggesting its possible antimicrobial mechanisms on the cell wall and membrane integrity.

​The prevalence of Type 2 diabetes mellitus (T2DM) is increasing worldwide and many of these affected individuals remain unidentified. Undiagnosed T2DM may impose substantial public health implications because these individuals remain untreated and at risk for complications. The objective of this study was to determine the national prevalence of undiagnosed T2DM and to identify the associated risk factors. A nationwide cross-sectional study was conducted involving 17,783 respondents. Two-stage stratified sampling design was used to select a representative sample of the Malaysian adult population. Structured validated questionnaires with face to face interviews were used to obtain data. Respondents, who claimed that they were not having diabetes, were then asked to perform a fasting blood glucose finger-prick test by Accutrend GC machine. The prevalence of undiagnosed T2DM was 8.9% (n=1587). The highest percentage of undiagnosed T2DM was found among males (10.2%), 55-59 years old (13.4%), highest education attainers of primary school (11.1%), Indians (10.3%), married (10.3%), working (8.9%) and living in the urban areas (9.2%). Multivariate analyses showed that factors associated with undiagnosed T2DM were gender, age group, ethnicity, marital status, obesity and hypertension. This study found an increasing trend of undiagnosed T2DM in Malaysia compared to 2006. This finding is alarming as risk factors associated with undiagnosed diabetes were related to most of the socio-demographic factors studied. Therefore, early diabetic screening is crucial especially among adults aged 30 and above to prevent more serious complications of this disease.​

?AlM: To evaluate the effect of different methods in managing punctual and canalicular stenosis as a complication of viral conjunctivitis.
?METHODS: A retrospective cohort study, including 35 cases of punctal stenosis post-viral conjunctivitis. Cases were diagnosed clinically and treated after 4wk of complete remission from epidemic keratoconjunctivitis. Patients were treated with mechanical dilatation, insertion of perforated silicon punctual plugs or the use of Mini-Monoka stent.
?RESULTS: Six out of 35 ( 17. 14%) had a satisfactory outcome by punctal dilatation alone. Punctal dilatation with insertion of perforated punctal plugs was done in 20 cases ( 57. 14%). Nine cases ( 25. 71%) had punctal dilatation with Mini - Monoka tube insertion. Disease severity and the use of Mini-Monoka silicon tube did not correlate with bilateral eye involvement or involvement of both upper and lower punctum.
?CONCLUSlON: Management of punctal occlusion post viral conjunctivitis may be treated easily using perforated punctal plugs. Silicon intubation with Mini-Monoka might be needed to manage resistant cases.

The aim of this study was to study the genotype of a hospital collection of Group B Streptococcus (GBS) from invasive and non-invasive sites. Fifty-one pre-characterised human of GBS were re-identified and further analysed by multilocus sequence typing (MLST) in relation to previously published serotypes. Fifteen sequence types (ST) were found with ST1 being the most predominant. ST1 was also associated with majority of the invasive isolates. The genotypic distribution patterns of GBS in this study were largely in agreement with previous reports from other countries indicating the tendency of certain genotypes to prevail in human infection settings.

Seeds of a Chinese traditional medicine plant, Cochinchina momordica were used in the present study for the improvement of influenza vaccine (H5N1) in chicken. Crude extraction from Cochinchina momordica seed (ECMS) was obtained by ethanol extraction method. In experiment No. 1, two weeks old chickens were immunized with influenza vaccine (H5N1) alone or combined with ECMS (5, 10, 20, 40 and 80 microg/dose). Serum IgG antibody levels (by ELISA) as well as effects on daily weight gain were measured on 0, 7, 14 and 28th day after immunization. Results revealed that all ECMS groups numerically increased the antibody levels while 10 and 20 microg/dose groups significantly (P<0.05) enhanced total IgG antibody on day 28, when compared with control. Average daily weight gain was also significantly higher in 20 microg/dose ECMS group. Adjuvant effect was also confirmed in experiment No. 2 when chickens were immunized with 20 microg/dose ECMS and antibody titer was measured through hemagglutination inhibition (HI). It is concluded that ECMS has potential to improve the immune responses and deserve further study as an adjuvant.
Agriculture ; methods ; Animals ; Chickens ; Drug Combinations ; Drug Synergism ; Drugs, Chinese Herbal ; administration & dosage ; Influenza A Virus, H5N1 Subtype ; drug effects ; Influenza Vaccines ; administration & dosage ; Influenza in Birds ; prevention & control ; Magnoliopsida ; chemistry ; Poultry Diseases ; prevention & control ; Seeds ; chemistry ; Treatment Outcome ; Vaccination ; methods